Financial Hardship and Waiving of Fees

As Community Health Centers, our goal is to provide comprehensive care without having healthcare be a financial burden to our patients. We never want patients to have to make a choice between seeking care or not seeing care because of their inability to pay a bill. HRSA allows health centers (regardless of payor) to be able to waive or reduce fees based on circumstances. In fact, it’s not just an option but a requirement that CHCs have policies or procedures in place to waive or reduce fees. This requirement can be found in Chapter 16 of the HRSA Compliance Manual: Billing and Collections, Element H. 

A few things which need to be remembered when evaluating your process to waive or reduce fees are:

  • The policies and procedures must contain the circumstances in which to waive or reduce fees. Examples of provisions may be a patient’s loss of a spouse, homelessness, living in a shelter, loss of employment, displaced due to a fire, or a declared emergency or pandemic. The community health center gets to decide what the circumstances are.
  • Waiving or reducing fees procedures are applied regardless of a patient’s income level, regardless of whether they are using the Sliding Fee Discount Program, and regardless of their payor (insurance, Medicare, Medicaid).  Patients should be able to complete a financial hardship form to determine if they qualify.
  • Waiving or reducing fees policies must be approved by the Board of Directors. This board responsibility is listed under Chapter 19: Board Authority, Element D.


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